A retrospective cohort study of matched pregnant and nonpregnant women with Hodgkin lymphoma (HL) treated with chemotherapy showed no significant difference in patient survival. The findings from this study were published in Lancet Haematology
Studies investigating the management of Hodgkin lymphoma during pregnancy are limited. A main aim of this study was to evaluate the clinical outcomes of both mother and child when the patient was treated with antenatal chemotherapy vs not treated. Furthermore, pregnant women with HL were matched with nonpregnant women with the disease, both treated with chemotherapy, to assess the impact of pregnancy on patient survival since the physiologic changes associated with pregnancy have the potential to influence chemotherapy-associated pharmacokinetic parameters.
This multinational study included data for 134 women with Hodgkin lymphoma during pregnancy between January 1, 1969, and August 1, 2018, who were registered in the International Network on Cancer, Infertility and Pregnancy (INCIP) database. In addition, 211 nonpregnant women aged 41 years or younger treated with standard doxorubicin, bleomycin, vinblastine, and dacarbazone (ABVD) chemotherapy at 3 tertiary cancer centers since January 1, 1997, were matched according to disease stage, prognostic score, and period of presentation with 77 patients with HL diagnosed during pregnancy who also received treatment with the same regimen, although not necessarily during pregnancy.
Of the cohort of 134 pregnant patients, 54% received antenatal chemotherapy, 42% did not receive treatment during the antenatal period, and 4% were treated with radiation therapy only. Notably, while only 6% of pregnant patients received antenatal chemotherapy prior to 1995, 67% underwent this treatment in the period covering 2005 to 2018.
With respect to neonatal outcomes, exposure to antenatal therapy was not associated with significant differences in the incidence of neonates considered small for gestational age (22% exposed to chemotherapy vs 15% not exposed; P =.455) or in rates of admission to the neonatal intensive care unit (29% vs 33%). However, exposure to antenatal chemotherapy was significantly associated with lower neonatal birth weight (P =.035).
Regarding obstetric outcomes, compared with pregnant women who did not receive antenatal therapy, those treated with chemotherapy were more likely to experience preterm contractions (12% vs 7%) and premature rupture of membranes (5% vs 0%).
At a median follow-up of 54.5 months, 5-year overall survival (OS) rates for pregnant and matched nonpregnant patients treated with chemotherapy were not significantly different. For example, 5-year OS rates for women with early-stage disease were 97.3% and 98.3% for pregnant and nonpregnant patients, respectively. For those with late-stage disease, rates of 5-year OS were 100% and 96.2%.
Furthermore, no difference in OS was observed between pregnant patients treated with antenatal chemotherapy and nonpregnant controls within the subgroup with early stage disease, or between pregnant and nonpregnant patients with early-stage disease when there was a delay of more than 35 days between HL diagnosis and chemotherapy initiation.
The study authors noted that “data from this cohort suggest that ABVD during pregnancy for HL does not affect maternal survival, but however might affect fetal growth, emphasizing regular obstetric follow-up in this high-risk population.”
Maggen C, Dierickx D, Lugtenburg P, et al. Obstetric and maternal outcomes in patients diagnosed with Hodgkin lymphoma during pregnancy: a multicenter, retrospective, cohort study [published online September 26, 2019]. Lancet Haematol. doi: 10.1016/S2352-3026(19)30195-4